Demonstration that phosphorescent 6-bromo-2-naphthyl sulfate can be used to probe heme accessibility in heme proteins.

The phosphorescence properties of 6-bromo-2-naphthyl sulfate (BNS) in aqueous solution were studied. The phosphorescence lifetime is several hundred microseconds and is self-quenched. Although a fluorescent photoproduct is formed from BNS, it does not interfere with the decay properties of triplet-state BNS and its utility as a probe of the accessibility of the heme group in heme proteins. Quenching of BNS phosphorescence does not occur for the non-heme protein lysozyme and apomyoglobin but occurs by a dynamic mechanism with a quenching constant of 1-2 x 10(9) M-1 s-1 for cytochrome c and myoglobin and with a quenching constant of 6.2 x 10(9) M-1 s-1 for protoporphyrin IX. The phosphorescence of an inclusion complex of 1-bromonaphthalene and beta-cyclodextrin is not quenched by heme-containing proteins. The temperature and viscosity dependencies of the rate with which BNS phosphorescence is quenched by microperoxidase-11 are consistent with unit quenching efficiency. These results indicate that quenching of BNS phosphorescence occurs only upon contact with the quencher, and the quenching constant can be used to assess the degree of accessibility of the heme group.

Oesophageal ulceration by tuberculosis: a rare cause of dysphagia.

We report on a 58-year old female patient from Afghanistan, who developed a dysphagia within 3 weeks of arrival. On the basis of radiological and endoscopic examination, an oesophageal ulcer was regarded as a malignant tumour, but because of weight loss, fever and night sweats (B symptoms) the question of tuberculosis was also considered by the pathologist. Histological assessment of biopsies produced proof of epithelioid cell granulomas with marginally polygonal giant cells of Langhans-type, as of acid-fast bacilli. In a bacteriological test, three different types of mycobacteria were found. With adequate anti-tuberculosis therapy, the oesophageal ulcer and the mediastinal lymph nodes visible in the computed tomograph soon disappeared, and the patient became free of symptoms. The clinical picture was interpreted as a primary oesophageal tuberculosis with mediastinal lymph nodes as the primary complex. In cases of oesophageal ulcer or dysphagia, tuberculosis should be included in the differential diagnosis, particularly in patients from Asia.

[Prevention of stress-induced hemorrhage of the upper gastrointestinal tract in neurosurgical intensive care patients. A controlled, randomized double-blind study with ranitidine alone and in combination with pirenzepine]. / Prophylaxe stressbedingter Blutungen aus dem oberen Gastrointestinaltrakt bei neurochirurgischen Intensivpatienten. Eine kontrollierte, randomisierte Doppelblindstudie mit Ranitidin allein und in Kombination mit Pirenzepin.

During a controlled, randomized, double blind study, 30 patients of a neurosurgical intensive care unit were treated with ranitidin and placebo (group 1) or ranitidin and pirenzepin (group 2). No significant difference in the effectivity of both methods was established, presumably due to the small number of cases. The pH values of group 2 lay in the median above 3.5, whereby the difference only became statistically significant after a seven-day period of therapy. In how far the increase of the pH value represents the only factor of a stress ulcer prophylaxis requires further investigation, particularly in connection with pulmonary risks caused by this.

[Laparoscopic lysis of adhesions--a simple method of diagnosis and therapy of abdominal pain caused by adhesions]. / Laparoskopische Adhäsiolyse--einfache Methode zur Diagnose und Therapie verwachsungsbedingter Abdominalschmerzen.

Laparoscopy is a simple method for establishing abdominal adhesions, even in presence of typical abdominal pain. Provocation of pain with drawing the adhesions under local anesthesia is very helpful in achieving a selective adhesiolysis. 70% of our patients improved with the procedure and 29% were without any complaint.

[Preparation for colonoscopy: a reliable and easily implemented regimen]. / Koloskopievorbereitung: ein sicheres und einfach zu handhabendes Regime.

Three different colonoscopy preparation methods were tested in 150 out-patients who received colonoscopies, 50 in each group, a randomized prospective simple blind study. The original Golytely-recepture with three litres of liquid was tested against Clean Prep which has to be dissolved in four litres of liquid. Both receptures had the same isotonic salt solutions. The third group was a method with a laxans (X-Prep) including eating restriction lasting three days. The judgment criteria were the cleanliness of the bowel, the formation of foam and the subjective sensitivity of the patient during the preparation phase. The preparation with the three bags containing three litres of Golytely solution according to the original recepture proved to be the least troublesome for the patients and was the most efficient method when it came to cleanliness and the formation of foam. The costs of this preparation methods were lower than those of the other methods.

[Gastric stump cancer with osteoplastic metastases and microangiopathic hemolytic anemia]. / Magenstumpfkarzinom mit osteoplastischen Metastasen und mikroangiopathisch-hämolytischer Anämie.

In a case of adenocarcinoma in the anastomosis of a stomach resected by the Billroth II technique osteoplastic bone infiltration and microangiopatic haemolytic anaemia are described as paraneoplastic syndromes. Both phenomena open up a great deal of differential diagnoses for consideration. Even when the extended bone infiltration could already be observed, the primary tumor macroscopically in the stomach was not visible. Even an unremarkable B II anastomosis should be biopsied as a matter of routine.

[Stomach volume reduction balloon for weight loss: what is the justification for this controversial method?]. / Der Magenvolumen-Reduzierungsballon zur Gewichtsreduktion: Welche Berechtigung hat diese umstrittene Methode?

UNLABELLED: Overweight and extreme morbid obesity are a common problem in our society. There are many therapeutic options currently available, but none of them can be considered as being ideal. One of these therapeutic interventions is the implantation of an intragastric balloon under endoscopic guidance. PURPOSE: Investigation of the effect of intragastric balloon Implantation on weight reduction. PATIENTS AND METHODS: In a prospective (and in part blinded) study 4 groups of patients (n = 10 each) were evaluated. In group I and II an intragastric balloon was implanted under endoscopic guidance. Group II had an intensive additional therapy by a dietition. Group I was advised to restrict themselves to a 1500 kcal diet. Group III did receive a sham implantation and the same additional therapy as group II. Group IV served as a control group and did not receive any type of treatment except the advice to restrict themselves to a diet. All balloons were explanted after 6 months. The overall follow-up rate was 18 months with a regular control of patients body weight. RESULTS: Patient inclusion criteria were comparable in all 4 groups. After 6 and 12 months a marked weight reduction was observed in group I and II when compared with group III and IV. This weight reduction was stable over time and reached statistical significance after 18 months. Additionally the results of group II (intensive additional therapy by a dietition) were better than in group I. Patients of group IV gained weight. No major complications due to the im- and explantation of the balloon were observed. CONCLUSIONS: The application of an intragastric balloon seems to be effective with regard of weight loss. The patient gets the chance to learn a more effective diet regimen which in our study population had a long lasting effect. Implantation of an intragastric balloon seems to be effective for a selective and highly motivated subpopulation of obese patients.

[Primary and metastatic liver tumors--evaluation of tumor regression and response with regional cytostatic drug therapy by sonography and fine needle puncture histology]. / Primäre und metastatische Lebertumore--Beurteilung der Tumorregression bzw.-response unter regionaler Zytostase durch Sonographie und Feinnadelpunktionshistologie.

Primary and metastatic hepatic tumours--evaluation of tumour regression or response under regional cytostasis with sonography and fine needle puncture histology. The results obtained through the use of regional liver perfusion with a 5-FU-BCNU application on non-resectable hepatic metastases of colorectal tumours following primary curative removal of the primary tumour and primary hepatocellular carcinomas display comparable results to those specified in the literature after the use of 5-FUDR. The effectivity of the cytostasis regime is checked using histological criteria. The ultrasonically guided fine needle puncture can prove the success of the cytostasis regime on the basis of cytomorphologic criteria more reliably than has been the case up to now. Patients displaying histological signs of tumour regression have a significantly longer survival time than those displaying no signs of regression (12 +/- 9.2 vs 4.5 +/- 2.2 months; p less than 0.05).

[Renal oxalosis with renal failure after infusion of xylitol]. / Renale Oxalose mit Niereninsuffizienz nach Xylitinfusion.

HISTORY AND FINDINGS: Ten days after a complication-free operation for early gastric cancer a 61-year old man had a seizure and acute renal failure. INVESTIGATIONS: A percutaneous renal biopsy was performed to find the cause of the renal failure, which at times required several sessions of haemodialysis. TREATMENT AND COURSE: The seizure was thought to have been due to cerebrovascular deposits of oxalate crystals (renocerebral oxalosis). Parenteral xylitol had been given postoperatively, as a glucose substitute (total dose 1560g), together with other routine drugs. Primary oxalosis and other causes of secondary oxalosis had been excluded. CONCLUSION: Xylitol should not be used parenterally as a glucose substitute (banned in the USA).

[Occlusion of the inferior vena cava--a rare, but severe disease picture, easily diagnosed with ultrasound]. / Verschluss der Vena cava inferior--ein seltenes, jedoch schwerwiegendes Krankheitsbild, leicht durch Ultraschall zu diagnostizieren.

Vena cava inferior thrombosis can occur in many disease patterns. In the literature the vena cava inferior thrombosis is described in several case reports. Thrombosis of the vena cava inferior often leads to pulmonary embolism and influences the prognostic and therapeutic way definitively. This is important in the case of a real thrombus and also for "thrombotic tumorous material", which is not differentiated in the literature. Even if the pattern of a vena cava inferior thrombosis is very rare (in our patients 1%), early and safe diagnosis is very important. Abdominal ultrasound supplies a definitive clue to the diagnosis. The high diagnostic ranking in comparison to other imaging techniques is discussed. This is a definitive imaging technique which influences the therapeutic concept and prognosis.

[Whipple's disease--a rare cause of secondary amyloidosis]. / Morbus Whipple--seltene Ursache einer sekundären Amyloidose.

Two cases of Whipple's disease with secondary amyloidosis are described. One patient had a nephrotic syndrome, the other malabsorption. The chronic inflammatory stimulus of Whipple's disease is discussed as a trigger for the development of secondary amyloidosis. The clinical symptoms of seronegative arthritis, weight loss, chronic diarrhea, intermittent fever and lymphadenopathy may be the clue to the diagnosis of Whipple's disease. Peroral intestinal biopsy is the diagnostic procedure of choice. Adequate antibiotic treatment with a regimen of penicillin and trimethoprim-sulfamethoxazole is indicated and prevents the development of secondary amyloidosis.

Steady-state intravenous pharmacokinetics of pirenzepine in patients with hepatic insufficiency and combined renal- and hepatic insufficiency.

The steady-state intravenous pharmacokinetics of pirenzepine has been investigated in patients with chronic liver disease and others with combined chronic liver disease and renal insufficiency. The plasma clearance (CL) of Pirenzepine, steady-state plasma concentration Cmin(ss) and dominant half life t1/2 gamma were not significantly altered in the chronic liver disease group. In patients with renal and hepatic insufficiency, CL was reduced, t1/2 gamma was prolonged from 11.1 to 19.4 h and Cmin(ss) was elevated from 36 ng/ml to 66 ng/ml compared to healthy controls. Plasma concentrations remained in the therapeutic range and the dosage regimen was well tolerated. Adjustment of the dose of pirenzepine need be considered only in cases of severe impairment of both renal and hepatic elimination.

[Angiotensin-converting enzyme and 1,25-dihydroxyvitamin D3 in hypercalcemia of unknown origin]. / Angiotensin-converting-Enzym und 1,25-Dihydroxy-Vitamin D3 bei unklarer Hypercalcämie.

Sarcoidosis of the kidneys and liver without radiologically demonstrable lung involvement in a 44-year-old woman was shown to be the cause of a hypercalcaemia syndrome. The hypercalcaemia was presumably due to an increased production of 1,25-(OH)2-vitamin D3 which--like the increased angiotensin converting enzyme--is produced in the epithelioid and giant cells. Corticoid treatment normalized serum calcium and ACE levels and improved renal function. These observations demonstrate that measurement of ACE and 1,25-(OH)2-vitamin D3 levels is helpful in the differential diagnosis of hypercalcaemia, in view of the possibility of sarcoidosis, and should be among the diagnostic tests.